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David X. Cifu, MD, et al.

We looked at records of 613,391 Veterans from
the OIF/OEF/OND wars who used Veterans Health
Administration care at least once from fiscal years
2009 to 2011 to identify the prevalence of traumatic
brain injury (TBI), posttraumatic stress disorder
(PTSD), and pain. Of the Veterans, 9.6% were diagnosed
with TBI, 29.3% with PTSD, and 40.2% with
pain. The full polytrauma expression of all three
diagnoses was 6.0%. Of those Veterans with a TBI
diagnosis, the majority had a mental health disorder,
with nearly half having both PTSD and pain.http://dx.doi.org/10.1682/JRRD.2013.01.0006

Christina V. Oleson, MD, et al.

Persons with spinal cord injury (SCI) are at
increased risk of vitamin D deficiency, abnormalities
in parathyroid hormone, and heterotopic bone
formation. The purpose of this study was to explore
the relationships among these conditions. We studied
96 patients with SCI and found an increased risk of
elevated parathyroid hormone with deficient vitamin
D. Furthermore, the presence of elevated parathyroid
hormone led to risk of heterotopic bone formation.
Abnormal bone formation in joints such as the hip or
knee can contribute to pain and decreased mobility in
patients with SCI.http://dx.doi.org/10.1682/JRRD.2012.11.0206

Sheng-Che Yen, PT, PhD, et al.

We identified the relationship between error size
and the aftereffect retention in subjects with incomplete
spinal cord injury (SCI) during locomotor training.
We observed that subjects tended to make larger
errors when the resistance load was greater. Following
resistance load release, subjects showed an
aftereffect consisting of an increase in stride length.
Further, the aftereffect was retained longer in the
medium-resistance load condition than in the heavyand
light-resistance load conditions. This finding
suggests that a patient-specific resistance load condition
may be needed to facilitate retention of locomotor
adaptation in patients with incomplete SCI.http://dx.doi.org/10.1682/JRRD.2012.09.0175

Classifying prosthetic use via accelerometry in persons with transtibial amputations

Morgan T. Redfield, MSEE, et al.

We developed a system to identify when a person
with limb loss was wearing his or her prosthesis and
whether he or she was moving, standing, or sitting.
The system uses a commercially available accelerometer
(sensor) and custom processing software. We
tested the system in the laboratory by comparing
results with visual observations of subjects and outside
the laboratory by comparing results obtained
from two sensors. The system accuracy averaged
96.6%. The information provided by this system
may be useful to clinicians who are fitting prostheses,
selecting components, or training patients. It
may also be useful for automatic feedback control to
adjust prosthesis mechanisms based on activity and
posture.http://dx.doi.org/10.1682/JRRD.2012.12.0233

Upper-limb activity in adults: Referent values using accelerometry

Ryan R. Bailey, MSOT, OTR/L; Catherine E.
Lang, PT, PhD

Veterans who experience impairment to the arms
after an injury or illness can benefit from rehabilitation.
Our research provides a value of average
amount of arm activity that occurs in adults that was
obtained from a large sample of adults without arm
impairment. We also explored the relationship
between arm activity and conditions known to affect
physical activity that could also affect arm activity.
This information can be used by patients and therapists
to set outcome goals and to track progress during
rehabilitation of the arms.http://dx.doi.org/10.1682/JRRD.2012.12.0222

Preethi Thiagarajan, BS Optom, MS, PhD; Kenneth
J. Ciuffreda, OD, PhD

Vergence eye movement rehabilitation was performed
in 12 individuals with mild traumatic brain
injury who had oculomotor-based reading problems.
Vergence eye movement parameters were assessed
before and after the oculomotor rehabilitation. Following
oculomotor training, most vergence parameters
significantly improved and/or normalized. In
addition, nearwork-related symptoms were reduced
and visual attention improved. No improvement was
found following placebo training. The findings suggest
the presence of considerable residual neurovisual
plasticity in these individuals.http://dx.doi.org/10.1682/JRRD.2012.12.0235

Nine people with transfemoral (above-knee)
amputation tried two different socket types that both
used a vacuum as the method of suspension. One
type of socket had traditional high trim lines, which
includes the perineum. The trim lines on the other
type of socket were well below the perineum.
X-ray was used to measure how these lower trim
lines would affect the femur and the movement of the
socket during weight and non-weight bearing. Skin
pressure was also measured. Finally, all the subjects
were asked which socket they preferred. The results
showed no difference between the two sockets in the
effect on the femur and socket movement. However,
skin pressure was improved and all of the subjects
preferred the socket with the shorter trim lines. The
implications of this study were that vacuum suspension
may assist in a more comfortable brim socket
design for people with above-knee amputation.http://dx.doi.org/10.1682/JRRD.2013.01.0003

Design and evaluation of two different finger concepts for body-powered prosthetic hand

Gerwin Smit, MSc, PhD, et al.

Current body-powered (BP) prosthetic hands
have stiff fingers and require a large amount
of input energy by the prosthesis user to produce a
limited pinch force at the fingertip. Two new finger
prototypes were designed, constructed, and evaluated.
One finger was driven by a pulley and a cable;
the other was driven by a hydraulic cylinder. The
fingers enable the construction of an articulating
BP prosthetic hand that is lighter, can pinch harder,
and has a higher energy efficiency than current BP prosthetic hands. Of both tested fingers, the hydraulic
cylinder finger is the most suitable because it
requires less input energy.http://dx.doi.org/10.1682/JRRD.2012.12.0223

Matthew L. Maciejewski, PhD, et al.

Veterans hospitalized for hip fracture are discharged
to a range of settings for rehabilitation and
care, but the factors that influence postsurgical discharge
setting are not well documented. The purpose
of the study was to examine the patient, facility, and
market factors that influence the choice of postsurgical
discharge setting. The Department of Veterans
Affairs (VA) offers a comprehensive spectrum of
rehabilitation care for veterans eligible for surgical
treatment in VA facilities, so examining patterns of
postacute care setting choice for a prevalent type of
surgery provides unique data to inform clinical and
policy discussions.http://dx.doi.org/10.1682/JRRD.2013.02.0041

Circumstances and consequences of falls among people with chronic stroke

Arlene A. Schmid, PhD, OTR, et al.

People are at great risk for falls after chronic
stroke. However, the reason for falls and consequences
are not well known or understood. We found
that falls occurred during activity and mobility as
expected, but also were due to impaired mental and
physical states, i.e., forgetting to tie a shoe or to use
an assistive device. The falls in this study were
related to high medical utilization and a large number
of injuries. Prevention of falls may require selfmanagement
of such multiple risk factors coupled
with physical activity.http://dx.doi.org/10.1682/JRRD.2012.11.0215

Power mobility with collision avoidance for older adults: User, caregiver, and prescriber perspectives

Rosalie H. Wang, BSc (OT), PhD, et al.

Collision avoidance technology may make power
wheelchairs and scooters safer for use by people with
age-related changes or injuries resulting in physical,
sensory, and cognitive disabilities. Much technology
has been in development, but little is known about
how consumers feel about this technology. As such,
we interviewed power mobility users, caregivers,
and prescribers (occupational therapists) to see how
they feel about the design and usefulness of collision
avoidance. They identified several safety and driving
concerns that may be addressed by collision avoidance.
Understanding consumers– views can help make
future technology more beneficial and acceptable.http://dx.doi.org/10.1682/JRRD.2012.10.0181

Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot study

Hugo Senra, PhD, et al.

This study contributes to the understanding of
depression in adults with irreversible vision loss. The
goal was to provide new insights into the relationship
between young and middle-aged adults– experiences
of vision loss and depression. Such insights could
explain why some patients with vision loss are more
likely to be depressed and have more problems coping.
The current findings highlight the potential role
of patients– self-awareness of impairment, perceived
social support, and length of rehabilitation in depression
after vision loss. It is suggested that emotionfocused
coping might also be adaptive, not just a sign
of maladjustment as other research has shown.http://dx.doi.org/10.1682/JRRD.2012.08.0138